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Focus on prevention to control the growing health budget

Australia spends more than $130 billion each year on health, approximately 9.2% of our GDP. The outcome of this and other investments is that our life expectancy puts us very high on the global “league…

Preventative health programs, like the one against skin cancer, aresuccessful and highly cost effective. Chelsea Nesvig

Australia spends more than $130 billion each year on health, approximately 9.2% of our GDP. The outcome of this and other investments is that our life expectancy puts us very high on the global “league table”.

But a recent Grattan Institute report has pointed out that health expenditure is one of the major drivers of budget deficits. Growth in health spending above GDP over the past ten years was greater than the growth above GDP of all other spending combined.

There’s growing concern across the community that we will have to ration our health resources. We already do, quite profoundly. But there are areas of waste. The fact that “Australia is paying more than $1.3 billion a year too much” for our national pharmaceutical bill as outlined in another Grattan report means this money could be spent on better care and prevention.

This is particularly true for those with least access to health-care services. As a nation steadfastly (rhetorically at least) committed to justice and egalitarianism, this money could be much more fairly and effectively spent on a national oral health-care program or make a major contribution to the national disability insurance scheme.

It isn’t only the drug bill where we could save billions but also in the area of medical diagnosis and intervention. A recent article in the Medical Journal of Australia outlined some of the 150 potentially low-value health-care practices that doctors could be discouraged to use. Among these are included arthroscopic surgery for knee osteo-arthritis and caesarean sections without a medical reason for it.

Then there are the futile end-of-life treatments on which we spend enormous amounts even though they neither enhance nor prolong life. Elderly patients with poor prognosis cancer should not be spending their last days in intensive care units, receiving “…advanced life support interventions such as endotracheal intubation, feeding tubes and cardiopulmonary resuscitation (CPR).”

There is also the wasted spending on poorly-designed and poorly-researched public education campaigns, such as the Swap it, Don’t Stop it campaign.

But can we spend more wisely and, at the same time, get better outcomes? Although most would happily agree with Benjamin Franklin’s adage that “an ounce of prevention is worth a pound of cure”, we fail to invest in accordance with this saying. In fact, we do exactly the opposite.

There are a few areas where we could be much smarter and, not surprisingly, they are in prevention. As one of the best researchers in epidemiology Geoffrey Rose said, “It is better to be healthy than be ill or dead. That is the beginning and the end of the only real argument for preventative medicine. It is sufficient.”

So where have preventative health’s “best buys” been and what are the some of the others? There are many – tobacco control, road trauma prevention, skin cancer and immunisation to name a few. These have all had great returns on investment, and their aim was not only to prolong life but to enhance its quality.

Skin cancers are among the most costly of cancers, and prevention programs, such as Sun Smart, have been repeatedly shown to be successful (averting more than 100,000 skin cancers between 1988 and 2003 in Victoria alone) and highly cost effective. These programs have a return of $3.60 for every dollar invested.

What simple things could we be doing?

Salt is a major contributor to high blood pressure, which, in turn, is a major cause of strokes and heart attacks. We could reduce salt in our food without really noticing. It’s been estimated that $20 million spent on a national food reformulation campaign to reduce salt would get us the same health improvements as $1.5 billion spent on antihypertensive drugs.

Reducing children’s exposure to junk food advertising would the cheapest and most effective way to reduce obesity. Australian children are currently exposed to extremely powerful, pervasive and “nannying” advertising that is much more powerful than any ads governments have ever been able to produce. This year, summer was brought to us by McDonalds, Joyville by Cadburys and happiness came to us courtesy of Coca Cola. How lucky we are.

According the American Public Health Association, if 10% of US adults began walking regularly, they could avoid $5.6 billion in heart disease costs. Every $1 invested in a child safety seat saves $42 in prevented medical costs, and routine childhood immunisation programs save 33,000 lives.

Listen to those who, besides government, bear the risk of spiralling health care costs – business and the insurance industry. We can learn from the United States where health-care costs are rocketing.

A recent report by MetLife (a very large US Insurance company), talks of a potential health “train wreck” in the near future. It states that this could be mitigated by increases in education, health literacy and prevention, particularly in workplaces. One health and well-being program they describe reduced absenteeism by 80% and saved $1.5 million in salaries.

If Australia is to get better health outcomes at a time of fiscal constraints, it will need to make tough decisions. Surprisingly, many of these decisions won’t cost much and may even raise money (tobacco taxation and reducing salt for instance). Taking heed of Benjamin Franklin and practicing what he preached would be a great start.

This is the fifth part of our series Health Rationing. Stay tuned for more articles in the lead up to the May budget or click on the links below:

Part one: Tough choices: how to rein in Australia’s rising health bill
Part two: Explainer: what is health rationing?
Part three: A conversation that promises savings worth dying for
Part four: Phase out GP consultation fees for a better Medicare

Join the conversation

111 Comments sorted by

    1. Gary Cassidy

      Monash University

      In reply to Janeen Harris

      RE: "How about stopping the nonsense of advertising "low fat" when it's high sugar, "all natural" when its high in fat, sugar or salt, and "healthy" when it isn't."

      Plain packaging for food and edible stuffs? With only a photo of the product (exactly as it is inside the box), ingredients and nutritional information listed. I suspect that would have a good return on health dollars.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Gary Cassidy

      Plain packaging of food stuffs - I like that idea.

      And no commercial TV for kids.

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    3. Gary Cassidy

      Monash University

      In reply to Sue Ieraci

      Hi Sue,

      RE "Plain packaging of food stuffs - I like that idea."
      Even without evidence ;-) (sorry just taking the piss a bit with a smile)

      RE "And no commercial TV for kids"
      A book I'm currently reading details how advertisers are much more creative with advertising to children than just TV. Cartoon characters, situational familiarisation (a pie at the footy type stuff), on-line games... I think regulating these techniques out when aimed at children is a necessary start. I also believe that…

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Gary Cassidy

      Gary - I get that you are taking the piss - but I don't need evidence to like stuff, only to proclaim that it works!

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    5. Simon Kerr

      observer

      In reply to Janeen Harris

      Maybe we should go even further and remove the term 'food' from the phrase 'junk food'. I find it difficult to see such artificially sugar laden productions as actual food.

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  1. John Doyle

    architect

    A major driver is vested interests distorting the health "industry", not to mention a form of organised crime!
    Here is a recent video about statins;
    <http://youtu.be/iZctVYxiW2w>;
    "statin nation"
    Once seen it will become clear statins are an unnecessary drug and therefore should not be subsidised.
    Scientific studies funded by pharmaceutical companies should be vetted independently and not swallowed whole. It's not our health that matters to them, it's their profit.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to John Doyle

      The evidence-base for statins is nicely summarised at this site:
      http://www.thennt.com/?s=statins

      In short, there is no evidence of benefit for statins short-term after acute myocardial infarct (heart attack), but some benefits in reduction of death, repeat heart attack and stroke, greatest in the group that already had coronary disease, with some risk of developing diabetes.

      Like all preventative medications, the potential benefit reduces in advanced age.

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    2. John Doyle

      architect

      In reply to Sue Ieraci

      Interesting summary indeed.
      Any more nails in the coffin are welcome!
      Anyone been able to access the you tube video yet?
      It goes for 65 minutes.

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    3. Judith Olney

      Ms

      In reply to John Doyle

      Hi John, the link in your third post works fine, you can click it to go to the youtube video, no problems.

      Thanks for posting this video, very interesting, and very important.

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    4. Sue Ieraci

      Public hospital clinician

      In reply to John Doyle

      Nails in the coffin?

      So you wouldn't recommend statins for secondary prevention in people with coronary disease, John? Why not?

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    5. John Doyle

      architect

      In reply to Judith Olney

      Yes, it means its over to us the public to change the situation. As long as governments and professionals are in thrall to these vested interests we are going to get the bad health outcomes we all see already around us.

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    6. Sue Ieraci

      Public hospital clinician

      In reply to John Doyle

      Where did I get that idea? Directly from your post, which said:

      "Any more nails in the coffin are welcome!"

      Sorry if I misunderstood - but what did you really mean by that?

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    7. John Doyle

      architect

      In reply to Sue Ieraci

      I meant it in a broader context. Statins are mis prescribed for say 75% of people. I wouldn't have it on the PBS except for those few who you mention where it does have benefits.
      Did you look at the video?

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  2. Chris Tandridge

    CEO

    So, if I understand this correctly our Govt, of whatever persuasion, is unable to invest/use the health monies correctly. Adding to this we now have a Govt/opposition discussing how they can raise more money, via Medicare levy, to spend on an undoubtedly worthy section of our community. A section of our community who I must admit I thought would have/should have already received a good % of that M money.
    Is it just me who sees a potential issue with this? How much of these fabulous sums of money that they talk about will actually be spent where and on whom it should be? Will we add this to the same debate of monies misspent, and wonder yet again how it all went wrong?

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    1. Terry J Wall
      Terry J Wall is a Friend of The Conversation.

      Still Learning at University of Life

      In reply to Chris Tandridge

      Chris, you are absolutely right. Australia has been averaging about $2000 per person per year. Now if we take a leaf out of the USA's experience, we are headed for $8000 per head per year.
      The problem is that US life expectancy over the last 10 years or so, has dropped 20 places down to 40th in the world.

      Giving money to an industry reliant on disease for survival is plain dumb, obviously; but what are the alternatives you ask?

      I would personally start with making the showing of three food…

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      Terry Wall, I'm all for teaching children about healthy diet (that's already part of the curriculum in our primary schools) but some of your other assertions need correcting.

      Whatever the risks of trans-fats, it is not true that they "coat the cell walls and prevent what little nutrients people eat, entering the cells where they are needed."

      Salt is salt - sodium and chloride are essential to life, but associated with high blood pressure if consumed in great excess.

      I see that you are promoting and selling mineral supplements. Where is the evidence that we are all deficient in minerals?

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    3. Chris Tandridge

      CEO

      In reply to Terry J Wall

      Thank you Terry for your response. I accept all the points raised in relation to the various products that impact adversely on our nations health. IF we had a Govt, of whatever persuasion, who had sufficient internal fortitude we might have some serious action. As it is, we find Obama powerless with his efforts, a demonstration that the President is (a) NOT the most powerful man in the world, and (b) Political solutions are doomed as long as there is compromise after compromise after compromise…

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    4. Terry J Wall
      Terry J Wall is a Friend of The Conversation.

      Still Learning at University of Life

      In reply to Sue Ieraci

      Sue, let me explain if I can (after 25 years of passionate research with hopefully an open mind)

      Would it not be fair to say that the standard mantra of less smoking, sugar, fat and salt (while undoubtedly helpful) is not quite the whole picture? There is something else missing? Or do we think that 70 years of unregulated corporate influence has not degraded refined food? That the nutritional integrity of our food is OK and the bits that are removed and fed to animals (minerals) don't matter…

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      Terry Wall - where is your research published? Have you measured mineral levels in human subjects, or tracked the incidence of deficiency?

      Refined salt is not at all like refined sugar. Salt is a compound of sodium and chloride - both of which are essential electrolytes in human cellular function. In gross excess, salt is harmful - "refined" or not.

      As your role is to sell mineral supplements to the general public, where is your evidence that the average person needs to purchase mineral supplements? Do you have studies showing that diabetics are zinc or chromium deficient?

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    6. Terry J Wall
      Terry J Wall is a Friend of The Conversation.

      Still Learning at University of Life

      In reply to Sue Ieraci

      Hi Sue
      My research is published in a book titled "Nature's Power. The Importance of Minerals in a Healthy Diet". You could read it because the subject is way to big to explain in a blog and I offer a free E-Book version..

      Regarding the truth of what I am saying: You have to believe me that I have been trying to get some researcher or medical professional to show interest or 15 years. I have had the Head of the Preventative Medicine at the Otago Medical School (not current one) admit that "you would not expect us to promote it would you". Nudge and wink!

      I am not an idiot nor am I obsessed. If I have a talent it is that I have retained the ability to see the big picture and quite frankly sort of smells. :)

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    7. Judith Olney

      Ms

      In reply to Terry J Wall

      Thanks for your posts Terry, I would like to see much more research, and education of health care providers, on the role of minerals in our health and well being.

      Most people would have no idea the are deficient in various minerals, unless they specifically ask their doctors to test for various levels. I have a friend who suffered regular panic attacks, and through working with her doctor, she found out she was severely deficient in magnesium and potassium. She supplemented both these minerals…

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    8. Terry J Wall
      Terry J Wall is a Friend of The Conversation.

      Still Learning at University of Life

      In reply to Judith Olney

      Hi Judith
      thank you for your feed back. Calcium and Magnesium are what you can call sister ships (and they are large ones as well), so well done supplementing with both. The ratio is important so I am a bit interested where you live (UK or Australia) and of course what you eat makes a diff as well. Like no dairy products tends to make the need of additional Mg unnecessary.
      Recently I spent a couple or years in the UK (The Chalk Islands) and found that I had to take additional Mg to offset the high levels of Ca in the diet (water especially). We like cheese and yogurt. Most people in Australasia are a bit deficient of Mg so I have added extra in In-Sync.

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    9. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      Terry - I do believe that you've been trying for a long time to get people to "show interest". What I'm less confident about is that there is evidence for a widespread mineral deficiency in our society - if you have that evidence, please share it.

      Zinc is found in many foods, and food sources of nutrients have been shown to be better for our health than supplements (benefit of fibre etc). Chromium is also found in a wide rage of foods, from egg yolk and nuts to wine and beer.

      It is unusual to have abnormalities of basic electrolytes - like sodium potassium, chloride - in the absence of kidney disease or drugs like diuretics. Magnesium deficiency is relatively common in alcoholics but not in the general population (it is frequently tested).

      While you are promoting and selling mineral supplements to the general public, it is clear that you have a vested interest in their widespread use.

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    10. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      Terry - on what basis do you say "Most people in Australasia are a bit deficient of Mg "

      Magnesium is frequently included in a battery of tests of electrolytes and renal function - I haven't observed it to be generally low in otherwise well people. What incidence have you measured?

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    11. Judith Olney

      Ms

      In reply to Terry J Wall

      Hi Terry, I'm in Western Australia, and the soil here is predominantly sandy soils deficient in important minerals, particularly ones such as selenium, and a range of other trace minerals. I now grow a lot of my own fruit and vege, (due to a lack of available fresh stuff, and the expense of buying what is available). I enrich the soil I grow my food in, with compost, and manures.

      I was so deficient in many different minerals even though I thought I was eating a pretty healthy diet, as well as…

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    12. Terry J Wall
      Terry J Wall is a Friend of The Conversation.

      Still Learning at University of Life

      In reply to Sue Ieraci

      Hi Sue,
      the reason I believe that Australians are likely to be deficient in Mg are twofold:
      Food is commonly boosted with Ca or in the case of fertilizers; Mg is normally ignored. If it was used instead of lime alone Ca, it would be applied in the form of dolomite.

      As I have no definitive evidence and I sell In-Sync Mineral supplement all around the world, and because Ca and Mg are so bulky taking up too much room in the capsule, I attempt to make a contribution towards the imbalance by including only 30 mg of calcium but 60 mg of Mg.

      This leaves enough room in the capsule for other extremely deficient trace elements like selenium, chromium zinc, copper and another four chelated plus a serious dollop of kelp powder and a serious dollop of humic shale.

      Anyway it works so that is the way it is staying at least for the medium term.

      By the way: it was not until we realised just how deficient we all are and upped the ante, that the results became Wow!

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    13. Terry J Wall
      Terry J Wall is a Friend of The Conversation.

      Still Learning at University of Life

      In reply to Judith Olney

      Hi Judith,
      you and I are singing from the same hymn sheet, even though I actually am a "humanist" as opposed to a religious person.

      I have also spent my upbringing and much of my time as a farm management consultant living on sand country: with its low cation exchange capacity (virtually nil organic matter and soil microbes to break down soil particles into minerals) you are right; very low mineral status.

      What you are doing in the garden is great but NOT i suspect nearly enough to offset…

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    14. John Doyle

      architect

      In reply to Terry J Wall

      Well, I don't know the science but magnesium supplementation has been for me very beneficial. I suffered for 40 years from renal colic and leg cramps at night. Now I rarely have cramps and no colic since 2003. I use a magnesium chloride"oil" spray on my legs and magnesium glycinate orally [which does not have a laxative effect]
      Obviously there will be some magnesium in our soils because photosynthesis requires it.

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    15. Judith Olney

      Ms

      In reply to Terry J Wall

      Having had horses in my area, I had a mineral analysis done on the soil, as it is also very important for animals to get the right amount of minerals, just as it is for people, this is how I found out how deficient the soils are around here. I also supplemented my horses feed with mineral and salt licks. As we eat food grown on the same soils, it is common sense that we would also need to supplement our mineral intake.

      I don't need lots of scientific studies to prove to me that supplementing…

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    16. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      "the results became Wow!"

      By results, Terry, do you mean your bank balance, or the number of people with proven deficiencies whose health was shown to have improved?

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    17. Sue Ieraci

      Public hospital clinician

      In reply to John Doyle

      John - Magnesium has roles as a micronutrient as well as as a "drug".

      As a nutrient, it is most commonly deficient in alcoholics and some people on diuretics (fluid tablets) - but not commonly in health people.

      As a medication, Magnesium in very high doses is a smooth muscle relaxant and has some effect on electrical conduction in heart muscle. Hence, your treatment for cramps (muscle relaxation) and its use in cardiac rhythm disturbances and in high blood pressure in advanced pregnancy (pre-eclampsia). In these cases, the aim is not to treat a deficiency but to use a super-nutrient dose for its other effects - which only happen at high doses.

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    18. John Doyle

      architect

      In reply to Sue Ieraci

      Magnesium is certainly good stuff! I'm a fan!
      It used to be common in hospitals, I think for what you mention, pregnancy, but was force superceded by big pharma?
      Is that so?
      I'm not sure how you would classify it when assessing the calcium/magnesium balance. A micronutrient or a drug? But either way supplementing with magnesium just might save your life, if much of the literature can be believed, or even some of it.

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    19. Judith Olney

      Ms

      In reply to John Doyle

      Thats interesting John, I am neither pregnant, an alcoholic, (I rarely drink alcohol), and I don't take diuretics, but I was very deficient in magnesium. I had some of the same symptoms as yourself, but none of those that my friend had, (who suffered panic attacks and anxiety). All due to a deficiency of Mg. (I, like my friend, were tested for deficiency).

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    20. Sue Ieraci

      Public hospital clinician

      In reply to John Doyle

      John - Magnesium is still used for severe pre-eclampsia in acute hospitals - it is supplied by "Big Pharma", but remains cheap and effective for this indication.

      I'm not sure what you mean by the "calcium/magnesium balance". Calcium metabolism is more closely linked to phosphate - both mainly extracellular ions (stored in bone etc). Magnesium is a mainly intracellular ion.

      You can read about them here:
      "The Essentials of Calcium, Magnesium and Phosphate Metabolism: Part I. Physiology" S. Baker and L. Worthley
      Critical Care and Resuscitation 2002
      (Full paper accessible at http://cicm.org.au/journal/2002/december/CPMI.pdf)

      The uses of macro-doses of magnesium that I talked about don't relate to a deficiency - they are using the muscle-relaxant effects of mega-doses of magnesium - essentially including magnesium toxicity in order to reverse a severe abnormality.

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    21. Terry J Wall
      Terry J Wall is a Friend of The Conversation.

      Still Learning at University of Life

      In reply to Sue Ieraci

      Sue, you have to be joking right?
      By wow means after 25 years of suspecting micro-nutrients (minerals) are the missing link to much better life health/ energy etc etc.

      By the way, when I see discussions regarding supplementing with this mineral or that, I wonder; I really do. Surely in 2013 people are aware of the dangers of taking extra of this or that mineral - unless they are organic and balanced and all included - you might as well not start.

      Let me give a couple of examples: I crushed…

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    22. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      "organic" minerals?

      John, you have to be joking, right?

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    23. John Doyle

      architect

      In reply to Sue Ieraci

      That link is a bit too eye watering for me, Sue. I don't know what is the "proximal tubule" or an "ascending loop of Henle" for example.
      What I have read is that we have an imbalance between the amount of calcium we take in with modern diets compared to the magnesium intake. I see it said at 6:1 when it should be about 2:1. and this has consequences just as omega 6 oils overwhelming omega 3 oils 20:1 instead of 2:1 has consequences for our health.
      Interesting your comment about macro dosages as a remedy. I've not seen that in the literature beforehand. Where is there info to find out more?

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    24. Sue Ieraci

      Public hospital clinician

      In reply to John Doyle

      John - that's physiology - that's one of the many clinical sciences learned in medical school, where people mistakenly think students don;t learn about "nutrition".

      The proximal tubule and ascending loop of Henle are par to the kidney structure where filtration and ion exchange happens - it's one of the places where the body regulates its internal environment, including pH (acid-base) and electrolyte balance.

      As the paper explains, calcium and magnesium are held in different tissues in the…

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    25. John Doyle

      architect

      In reply to Sue Ieraci

      Yes, indeed Sue. But funny how the medical world still gets it's basics wrong, still lets bad science through to become a major health scourge.
      Obviously I refer here to such highly praised experiments as the 6 Countries study by Ancel Keys and how everyone seemed to run with it, yet how wrong it has shown to be.
      Understanding the basics is not saving us here, at least not until now when realisation is finally cutting through.
      It pays to be cautious even within the profession and not jump to conclusions. Vested interests as paymaster of experimentation should have alarms always on full alert.

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    26. Sue Ieraci

      Public hospital clinician

      In reply to John Doyle

      John - please show me how "the medical world still gets it's (sic) basics wrong" (Ignoring your getting your basic grammar wrong...).

      Your comment was not "obvious" at all - the six countries study is not the basics of medicine. Medicine is based on the clinical sciences - anatomy, physiology, pathology and pharmacology. The detail of these sciences develops all the time, as new evidence emerges.

      I'm always amazed by people who quote the infective cause of peptic ulcer disease as an example of medicine's conservatism, then makes comments like "It pays to be cautious even within the profession and not jump to conclusions", or use examples like Vioxx. New models or evidence need to be sufficiently tested before becoming generalised, just like antibiotics for peptic ulcer disease.

      Could you please show me what you mean by "the medical world still gets it's (sic) basics wrong", John - or were you referring to one study?

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    27. John Doyle

      architect

      In reply to Sue Ieraci

      Quite the comedian aren't you Sue!
      So with all the obesity around there's no link to bad science according to you? The 6 countries study set nutrition, etc on the path to the "good health epidemic" you alone see today? No medical cause for the surge in CVD, metabolic syndrome, etc? No vested interests twisting research to boost profits? You see none of that?
      On the other hand you like to waste time calling up typos. Clever!

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    28. Sue Ieraci

      Public hospital clinician

      In reply to John Doyle

      John - the typo was incidental to my point - and amusing considering you were calling out the medical profession for "getting the basics wrong". That's what you said - copied from above: "the medical world still gets it's basics wrong,.."

      I was trying to explain to you what the medical world's "basics" actually are - the clinical sciences (of which you clearly have little knowledge or understanding).

      If I see an ugly building, do I conclude that "the architecture world has got its basics wrong"? No - I conclude that the builder didn't use an architect, or ignored what the architect said, or perhaps it was an unusually bad architect - not that the result invalidates the entire profession.

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    29. John Doyle

      architect

      In reply to Sue Ieraci

      No, Sue. I did say they get the basics wrong, but was not inferring every time. No matter how you defend it medical science can make bad choices. What has happened with nutrition has been a very serious failure of medical science to get the research vetted. Instead they said if it sounds plausible it must be OK [the 6 countries study]
      I don't understand how such a realisation is just out of reach of your understanding. People like you who are still pushing this error are the ones magnifying the evil done in the name of nutritional science.

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    30. Sue Ieraci

      Public hospital clinician

      In reply to John Doyle

      John - you appear to have very little understanding of how scientific evidence accumulates.

      Amongst a world of evidence in areas from the management of pregnancy-induced hypertension to the diagnosis of asthma in children, you seem to be fixated on one study that you have heard of. ANcel Keys and his collaborators carried out large international surveys in the 1950's and 1960's, exploring links between lifestyle and diet and disease. It was one of the first big population-based studies of its…

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    31. John Doyle

      architect

      In reply to Sue Ieraci

      Keys also carried out experiments on consciencious objectors during the war. You are still avoiding the obvious. Even if his own conclusions differed his work still led to the formulation of poor theories about healthy/unhealthy foods. Why the hell are you bringing up pregnancy induced hypertension into this?
      How about you getting fixated onto the thread instead?
      Have you seen the video I listed at the top of the discussion?
      Yes or no?

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    32. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      Terry - at work today (acute hospital) I had cause to review a day's worth of blood test results, as part of a quality assurance exercise.

      I paid particular attention to the ones where Magnesium had been measured as part of a biochemistry screen.

      I found twenty two patients had had their magnesium measured - people ranging from 17 to over 90 years old, all presenting with different issues. Of the twenty-two, there were two people with slightly low magnesium - both aged over seventy and on diuretics - all the rest in the normal range.

      Although it's just a quick look at one day's presentations, it does sample a sicker population than the general public, and doesn't suggest a high rate of magnesium deficiency in the general population.

      What have you found to be the general population rate of magnesium deficiency, and what levels did you find?

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  3. Greg Boyles

    Lanscaper and former medical scientist

    Our health budget is getting out of control is it?

    QUOTE
    Everyone who lives in Australia—excluding Norfolk Island residents—is eligible for a Medicare card if they:

    hold Australian citizenship
    hold New Zealand citizenship (documentation required)

    have been issued with a permanent visa
    have applied for a permanent visa (excludes an application for a parent visa—other requirements apply. Call us for more information).

    END QUOTE
    Well relinquishing our

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  4. Sue Ieraci

    Public hospital clinician

    It's a common myth that preventative health care saves dollars. While it is a worthwhile aim in itself to improve health and prevent suffering, the only way this could avoid expenditure on acute health care is if we stopped expecting more and worrying more.

    Unfortunately, health care demand doesn't work that way. There is no objective "enough" care or "enough" health or "long enough" lifespan. The healthier we get, the more we shift the goalposts. We no longer accept death in childbirth, or childhood…

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    1. Terry J Wall
      Terry J Wall is a Friend of The Conversation.

      Still Learning at University of Life

      In reply to Sue Ieraci

      Hi Sue
      cannot agree you on this at all:
      We are in fantasy land, however, to think that such an approach will reverse the escalation of acute costs - if anything, it will increase them.
      Give back the core health nutrients that are missing - the results will scare the hell out of you as you work in the industry. Have to read the book:
      http://www.in-syncminerals.com/downloads/NaturesPower-TerryWall.epub

      http://www.in-syncminerals.com/downloads/NaturesPower-TerryWall.mobi

      http://www.in-syncminerals.com/downloads/NaturesPower-TerryWall.pdf

      The mobi is for kindle, and the pdf for most others

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      No, Terry, I haven't read your book, but I know a little about health service needs over our lifespan, and how standards, expectations and risk aversion have progressed over recent decades. Have you read my articles and research?

      As I said before, looking after one's own health through choosing good parents, not smoking, not drinking excessive alcohol, eating a good diet of fresh foods and being immunised are all great aims in themselves.

      What they don't do, however, is reduced the expenditure…

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    3. Terry J Wall
      Terry J Wall is a Friend of The Conversation.

      Still Learning at University of Life

      In reply to Sue Ieraci

      Hi Sue

      You have to stay with the programme.. you can get there .. dont worry about the industry.. just care for the next generation and do yourself a huge favour.

      What I am telling is just about to be taken on board because it is self evident: It (a rich intake of micro-nutrients) works well with animals, birds, insects, fish, plants; we can accept organs from animals; why in the hell would you be so surprised that it works a treat with us?

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      John - I already spend lots of time caring for the next generation - and I don't even sell them anything.

      Of course we benefit from a diet rich in all the nutrients - I give that advice all the time. But buying some special formula from you, on the basis of your personal opinion? No thanks.

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    5. John Doyle

      architect

      In reply to Terry J Wall

      What you seem to be saying is at cross purposes, Terry.
      Say your regimen does indeed make us healthier it doesn't change what Sue says about major health care costs. It means with your results the end care costs are just delayed due to a longer healthy life for each adherent of your guides. We are all still destined to die.
      I earlier said we needed to stop Big Pharma from rorting the health care budget as is clearly the case with statins. Then if food corporations etc could get off promotion of unhealthy products we might make less trips to the doctors and need less prescriptions.
      This isn't going to happen from the top down until we as the public make it happen.
      But little of this will influence the end care cost spiral. The public needs to get realistic there too.

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    6. Judith Olney

      Ms

      In reply to John Doyle

      Hi John, if a person is healthier for longer, and remains healthy into old age, (as in not having any chronic diseases so not needing lots of expensive health care interventions), wouldn't this mean that there is less cost at the end of life?

      For example, my great grandmother lived an independent healthy life, eating well from her garden, cycling daily to buy her newspaper, milk and bread, and going dancing once or twice a week, up until the age of 96, which was when she died in her sleep one…

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    7. John Doyle

      architect

      In reply to Judith Olney

      Sure, Judith.
      Not everyone will be a burden on the healthcare budget. It's mostly about being in care at the end and all the costly facilities used to keep people alive, often disregarding their own wishes.
      Being healthier overall is obviously beneficial. We are more productive and less in need of the medical establishment.
      Just the same, as the ageing demographic shifts in numbers costs will rise. Being healthy will slow it but not reverse it.
      Your great grandmother ate what grandmothers used to recognise as food. It's not what most of us do now.
      Also another saying I like, german I think, is to "eat breakfast like a king, lunch like a prince, and supper like a pauper"

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    8. Judith Olney

      Ms

      In reply to John Doyle

      <"Your great grandmother ate what grandmothers used to recognise as food. It's not what most of us do now.">

      Yep, and she also ate a lot of things that we are told now are unhealthy. She ate lots of saturated fats, animal fats like butter, lard, suet, and never trimmed fat off meat. She made lots of cakes and biscuits, and ate much more than most people do now, the meals at her house were huge compared to what is recommended today, and we always had sweets after. We ate lots of vege and fruit…

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    9. Sue Ieraci

      Public hospital clinician

      In reply to Judith Olney

      It would be wonderful if everyone could remain perfectly healthy until they suddenly drop dead at an advanced age, not having required any health care.

      Unfortunately, it doesn't often work that way. What happens is that health care costs are displaced forward in age - fit 90 yr olds can now have the hip replacements that used to be reserved for the under-eighties.

      We can always find exceptions, like the (uncommon) smoker who lives into ripe old age - but that's not the norm. Very few people get to die suddenly in their sleep at a ripe old age without having deteriorating health beforehand.

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    10. Judith Olney

      Ms

      In reply to Sue Ieraci

      <"Very few people get to die suddenly in their sleep at a ripe old age without having deteriorating health beforehand.">

      I agree, my great grandmother was an exception to the norm, but, although people's health normally deteriorates with age, if there was more focus on keeping people healthy, through preventative means, the deterioration in health need not lead to hospitalisation, or medical interventions that are costly.

      For example, problems such as osteoporosis can be prevented or at least…

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    11. Judith Olney

      Ms

      In reply to Sue Ieraci

      Interesting , but it is an American study from almost 10 years ago, so not really all that useful in regards to Australia. America has a very different health care system, and one that is the most expensive in the world.

      Thanks anyway.

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    12. Sue Ieraci

      Public hospital clinician

      In reply to Judith Olney

      It's not the dollar amount that is significant, but the distribution. Can you explain how Australia;s pattern would differ?

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    13. Judith Olney

      Ms

      In reply to Sue Ieraci

      Why do you think the dollar amount is not significant? We have a completely different health system here in Australia, so I don't believe that the information is relevant to the topic of this article. I expect that in Australia we would have the same sort of distribution, that is that more money is spent towards the end of life.

      This however, does not give any indication of whether preventative health measures would see any significant drop in the overall health costs.

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    14. Sue Ieraci

      Public hospital clinician

      In reply to Judith Olney

      Judith - you don't seem to accept my explanations or references, so I'm not sure how much more I can explain.

      The data show is done IN THE CONTEXT OF preventative health measures. People in wealthy societies are living longer, and many remain active into old age. There are limits to the body's endurance, though, and so coronary disease, cancer, stroke etc, put off for decades, eventually manifest.

      Imagine your great grandmother was alive today, and whatever caused her to die in her sleep happened…

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    15. Judith Olney

      Ms

      In reply to Sue Ieraci

      Sue, I'm under no obligation to accept your explanations, and I gave you an explanation of why I think your reference was not relevant to the topic.

      I'm not really sure what you are trying to say with your hypothetical imaginings, and how this is relevant to preventative methods.

      What I think you are saying, is that the vast majority of people get healthcare that is not necessary when they reach the end of their lives. I agree, we should be looking at ways of cutting this cost, but how? Let…

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    16. Sue Ieraci

      Public hospital clinician

      In reply to Judith Olney

      Judith - you say "I'm not really interested in discussing what we already know happens, but in how we can change what happens." Essentially, then, you are speculating that all disease associated with advanced age can be prevented.

      What preventative care really means, however, is displacement. It's not possible to be perfectly well until you suddenly die because, in order for death to occur, some organ system has to fail. Even if you appear to be well until you have a sudden heart attack or stroke…

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    17. Judith Olney

      Ms

      In reply to Sue Ieraci

      <"Essentially, then, you are speculating that all disease associated with advanced age can be prevented.">

      No Sue, thats not what I'm saying at all, that would be unrealistic. I am saying that we could be looking at ways to help people be healthier, not prevent them dying. These preventative measures may enable people to not be such a burden on the health care budget, by not requiring such intensive care at the end of their lives, or during their lives.

      I am aware that there are preventative…

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  5. Greg Boyles

    Lanscaper and former medical scientist

    Our health budget is getting out of control is it?

    QUOTE

    Everyone who lives in Australia—excluding Norfolk Island residents—is eligible for a Medicare card if they:

    hold Australian citizenship
    hold New Zealand citizenship (documentation required)
    *********have been issued with a permanent visa *********
    *********have applied for a permanent visa (excludes an application for a parent visa—other requirements apply.**********
    Call us for more information).

    END QUOTE

    Relinquishing our immigration policy to people smugglers in Indonesia and else where WILL NOT improve our national health budget position!

    Because, as the number of illegal immigrants grows when we throw out the welcome mat, the greater will be our spending on providing them all with free health care!

    Another reason why going soft on illegal immigrants is not sustainable in the long term!

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  6. peter mackenzie

    Transport Researcher

    Professor Moodie mentions prevention of road trauma as one of preventative health "best buys". Thats true- however we started from a low baseline - and despite being up with the world's best at one stage, Australia is now lagging in terms of road deaths per head of population.

    More importantly, it would be a misnomer to call our road safety approaches a "system". There is much more that could be done, but change is agonisingly slow, with many barriers, including fierce resistance to change from various quarters.

    Some of the resistance comes from the very people and organisations supposedly working for safer road use. The underlying reasons are too complex and complicated to explain here, but I am happy to discuss/debate the confounding factors with anyone interested.

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  7. John Kelmar

    Small Business Consultant

    Finally a health article I agree with. Why is the Government so intent on prolonging life when the individual is incapacitated and incoherent?

    At 87 my mother was told that she required a triple heart bypass, and that she would live for another 5-8 years if she agreed to this procedure. The doctor charged over $50,000, and my mother was laid up in hospital for the last 6 months of her life.

    Surely was should be able to make our own decision on how long we wish to live without intervention of Politicians and Governments, otherwise we may end up like the population in the movie "Soylent Green".

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  8. Malcolm Riley

    Nutrition Epidemiologist at CSIRO

    This is a useful article with useful examples.

    I'm interested in the ironic application of the term 'nannying' to marketing of unhealthy food and drink to children. It is more typically used as a disparaging label for health promoting messages from the government. But a nanny is recognised to have the best interests of their charges at heart and might be adopted as an honourable term (leaving aside the concept of an 'evil nanny'). I understand that Professor Moodie is turning this framing around, but there can only be a narrow sense in which a marketer primarily has the best interests of their target in mind.

    Powerful, pervasive and duplicitous? Powerful, pervasive and disingenuous? Perhaps powerful, pervasive and primarily self-serving ...

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  9. christian haag

    CEO

    Hi Rob - can you provide a little background to "There is also the wasted spending on poorly-designed and poorly-researched public education campaigns, such as the Swap it, Don’t Stop it campaign".

    would be keen to understand your views on its failings.

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    1. Gary Cassidy

      Monash University

      In reply to christian haag

      I'm also interested in this "Swap it, Don’t Stop it" initiative. Potentially it could help people make better health choices. However, if poorly targeted and implemented it could be a waste of money. What if any measurable outcomes have been attached to it?

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  10. Colin MacGillivray

    Architect, retired, Sarawak

    An Catalyst TV programme showed Prof. David Goldstein medical oncologist at the Prince of Wales Hospital advocating exercise as a cure for illness, not just a way to avoid obesity or heart disease. It was noted that very few GPs prescribed it. (Search at the website for the report).
    The time must be coming when the health service needs to instruct doctors to prescribe actions for their patients not just drugs. Actions like - exercise, better diet, not smoking- which all just about free.
    And if patients don't take action let them suffer. Why on earth should tax payers help them if they don't help themselves?

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Colin MacGillivray

      "The time must be coming when the health service needs to instruct doctors to prescribe actions for their patients not just drugs. Actions like - exercise, better diet, not smoking- which all just about free."

      Mr MacGillivray - do you have evidence that the medical profession is not already doing this? Of the three things you mention, not smoking has the greatest health impact of all - the medical profession is firmly behind the quit smoking message.

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    2. Judith Olney

      Ms

      In reply to Colin MacGillivray

      Colin, that is a great idea for those that actually go to a doctor. I see a lot of people around my little town, that are overweight, don't exercise, drink excessively, eat a poor diet, but they never step foot in a doctors surgery, because they don't consider themselves sick.

      There are a lot of men here, (I'm not picking on men, but they are the ones that mostly exhibit this behaviour), although there are women who find themselves in the same position, that don't see a doctor from one year to…

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    3. Colin MacGillivray

      Architect, retired, Sarawak

      In reply to Sue Ieraci

      On the Catalyst programme it said that only 2% of doctors prescribe exercise. Seems low to me but that's my reference.
      Sue, do you have evidence for saying "Of the three things you mention, not smoking has the greatest health impact of all"
      Give me the evidence that smoking has a greater health benefit than exercise and better diet?

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    4. Colin MacGillivray

      Architect, retired, Sarawak

      In reply to Judith Olney

      Judith
      On another post I suggested establishing KHC's- Keep Healthy Centres- to provide the services that doctors don't have time to. I've brainstormed the idea (solo!)

      The places could occupy vacant shops whilst the owner sought long term tenants- so little or no rent.
      The equipment would be simple (and portable):
      Lots of pot plants and comfortable chairs (particularly at the entrance) to make the place welcoming.
      Weighing machines linked to a mobile phone app to save and report back to the…

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    5. Judith Olney

      Ms

      In reply to Colin MacGillivray

      Could work Colin, just a couple of things though, I can see commercial gyms kicking up a stink, as well as local councils, (insurance cover, venue rent and suitability, public liability insurance, and medico insurance as they will be giving consultations and advice to people), councils can be very pedantic about anything they might get sued for. The gym equipment would have to be certified fit for use, and trained people needed to supervise. Unless you went with having people sign a waiver, but even…

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Colin MacGillivray

      CDC:
      "Tobacco use is the leading preventable cause of death.
      Worldwide, tobacco use causes more than 5 million deaths per year, and current trends show that tobacco use will cause more than 8 million deaths annually by 2030.

      In the United States, smoking is responsible for about one in five deaths annually (i.e., about 443,000 deaths per year, and an estimated 49,000 of these smoking-related deaths are the result of secondhand smoke exposure). On average, smokers die 13 to 14 years earlier than…

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    7. Colin MacGillivray

      Architect, retired, Sarawak

      In reply to Sue Ieraci

      Hi Sue
      We do agree, smoking is a killer. I'm just of the opinion, in this debate about the Health Care costs, that the really cheap options- exercise and nutrition should get more priority. It is an awful fact in the UK that the tax on cigarettes is higher than the cost of treating cigarette health issues.

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    8. Colin MacGillivray

      Architect, retired, Sarawak

      In reply to Judith Olney

      Judith bring on the "rain on my parade" I love it! Honestly, the only way to bring ideas to fruition is to talk them through first. Then every objection can be considered and countered. A sedate forum like this is better than a live brainstorming session where the loudest voice often wins. (Well done the Conversation team).
      My 3 years as an elected member of (part of) Auckland Council certainly taught me all about bureaucrats. The way to bring them on board was to work behind the scenes, identify their misgivings and ensure there was no chance that they would be criticized. And ensure the mayor thought it was his idea!
      Rob Moodie- one person thinks KHCs are a good idea what do you think?

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    9. Judith Olney

      Ms

      In reply to Colin MacGillivray

      Ah you've been in local government Colin, now I know you understand exactly what it takes to get a good idea up and going. ;)

      I wish you luck, and would love to see your idea gain a foothold.

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    10. Sue Ieraci

      Public hospital clinician

      In reply to Colin MacGillivray

      I'm glad you agree, Colin, but it's not my personal opinion - it's what the data show.

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    11. Colin MacGillivray

      Architect, retired, Sarawak

      In reply to Sue Ieraci

      Not a good survey but this is current, May 4th:
      NHS treatment for smokers and the obese
      More than half of doctors across the UK have backed controversial measures to withhold treatment to smokers and the obese.
      According to a new survey around 54 per cent of those who took part said the NHS should have the right to deny non-emergency treatments to those who fail to lose weight or kick their smoking habits
      http://www.dailymail.co.uk/health/article-2136999/No-treatment-smokers-obese-Doctors-measures-deny-procedures-unhealthier-lifestyles.html

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    12. Judith Olney

      Ms

      In reply to Colin MacGillivray

      I found the comments at the end of the article really interesting Colin, they at least give me hope that we aren't all desiring a totalitarian state.

      I'll bet there would be a few lawyers champing at the bit to have some sort of system like the one suggested in the article. Why stop at smoking and obese people though? This system of refusing treatment to those who will not comply with government and doctors idea of how we all should behave, could be extended to a point where no-one would end up…

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    13. Colin MacGillivray

      Architect, retired, Sarawak

      In reply to Judith Olney

      Judith
      I hope my KHC idea is tried at least once in Australia, (I live in Sarawak Malaysia, where government hospitals are good and cheap but people pay to visit their doctor.)
      The idea that obese smokers don't get medical treatment is extreme and unlikely. But the health budget is limited and getting the best value for money is a necessity. So helping those that help themselves is one criteria for who gets what treatment.

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    14. Judith Olney

      Ms

      In reply to Colin MacGillivray

      I'd also like to see your idea of KHCs tried in Australia, I know in my own little town they would be very welcome indeed. It is the low income and poorer people who miss out on the opportunities to engage in healthy activities here, and there is a lack of information on making healthy changes to a person's lifestyle as well. Your idea for KHCs would enable the poorer people in my town to access information and equipment that is otherwise not available to them.

      Its interesting that these lifestyle…

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  11. ian cheong

    logged in via email @acm.org

    The benefits of healthy lifestyle are well known. Judging by the obesity epidemic, current behaviour is clearly winning over healthier behaviour.

    With a limited budget, current expenditure will trump investment with a long-term payoff. The potential payoff for prevention is likely to be several terms of government away. So politicians would rather fix hospital waiting lists or fund new drugs, than spend on prevention out of the health budget.

    Taxing unhealthy behaviour (eg cigarettes, alcohol…

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    1. Judith Olney

      Ms

      In reply to ian cheong

      Hi Ian, if any government wants to put a tax on sugar and processed foods, they will have to make sure that they do not simply make life hard for those on low or fixed incomes.

      Fresh food and vege, (healthy non-processed foods), are extremely expensive in my town, all must be transported in as there are no market gardens around here. It is cheaper for a person to buy a 1 kilo bag of frozen, fat laden chips, than it is for them to buy a 1 kilo of potatoes. It is cheaper for parents to buy fat…

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    2. Jan Burgess

      Retired

      In reply to Judith Olney

      Judith

      I afraid I can't agree with the often-quoted idea that cheap has to equate with unhealthy. In my experience, it is more a case of fast and convenient that equates with unhealthy.

      As a pensioner on a fixed income, I know all about trying to make a dollar stretch further. I have found it is cheaper to buy a lot of fresh produce in season and take the time to make my own soups and stews and freeze the result than to buy processed food (tinned, frozen or takeaways). The thing is, I'm…

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    3. Judith Olney

      Ms

      In reply to Jan Burgess

      Jan, I was taking specific examples from my own town, I live in a remote town in WA, in a semi arid mining area, 800kms from the city, and the closest town of any size is 400kms away. There are no market gardens as there is not the rainfall in this area to support growing fruit and vege, and we do not have water available for irrigation. There is some broadacre farming and meat production, but this is nearly all exported, and not sold to the local community.

      And here a bag of fat laden frozen…

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    4. John Doyle

      architect

      In reply to Judith Olney

      Sounds like yet another distortion the government could work on.
      We can't support people in remote areas only having access to poor food. That's really inequitable. Automatically health is compromised!
      Any ideas? I mean could local government set up some system where a community garden [1or more] is created and fresh food made available at minimal cost to residents?
      Even in a desert as long as water is made available a vegetable garden can work. A lot of the older country people still know how to preserve and cook with country foods. They still have agricultural shows which reward these skills. Someone could conduct classes in cooking.
      Maybe a bit more community and a bit less me, me!

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    5. Judith Olney

      Ms

      In reply to John Doyle

      We have a community garden John, but we have a lack of water, even though we have water tanks, over the last summer we have had little rain, we are hoping for more this winter. We also have a fairly transient population, FIFO and DIDO workers are not interested in community, and neither are the companies they work for.

      Local council are more interested in tourism and the chamber of commerce desires, than community needs, and would not likely approve more land for gardens, even if we had enough…

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    6. John Doyle

      architect

      In reply to Judith Olney

      Me,me didn't apply to you Judith but to large sections of our community more interested in themselves than in anything communitarian.
      You have lots of issues where you are, which makes a solution all the more difficult. My suggestion of the local government involvement was so they would offer plants, seeds, a site and advice to poor residents to get going. Unemployed have time to use to good effect if they can get motivated.
      These poor people have to do something towards their own good and using their time to improve their health is a good way.
      FIFO people are earning enough to g afford good food I should think, if they care.

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    7. Judith Olney

      Ms

      In reply to John Doyle

      I think that large sections of the community are only interested in themselves, but that is just a symptom of what is wrong with our consumerist society today. People are selfish, and greedy, and its mostly a case of "I'm alright Jack and bugger the rest of yous".

      This is also the reason why local government aren't interested in helping poorer residents with being able to have opportunities for better health. We do have a number of poorer people, both pensioners and unemployed helping out with…

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  12. George Crisp

    Medical Practitioner

    "It (Metlife Reprt) states that this could be mitigated by increases in education, health literacy and prevention, particularly in workplaces"

    How effective is advice to change behavior, if there are equal or more powerful counter-messaging from fast food advertising etc? And how can we encourage activity in cities built for car-dependance cities, without adequate public transport and cycle infrastructure, and recreational space and longer work hours, and with a grossly distorted food pricing…

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    1. Judith Olney

      Ms

      In reply to George Crisp

      The review you linked to certainly is well intended, and has some excellent points to be considered, and hopefully acted upon.

      Although that certainly hasn't happened in the UK, what they have opted for is austerity cuts, cuts to health and welfare, and more income inequality. Just the ticket to ensure that health outcomes for the poorest people are made worse.

      Its the same thing we can look forward to in Australia, regardless of who wins the next election.

      We are headed for greater inequality…

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    2. George Crisp

      Medical Practitioner

      In reply to Judith Olney

      I agree with much of your comment. But not so the use of"well intended" in this context; it is a report based on current data and information (in the UK) aimed at addressing known inequality. The term well intended introduces an emotive perspective that should be irrelevant.

      There are perfectly good economic, social and health reasons to address inequality.

      There will only likely be improvement if we start voting for parties that understand this and if, particularly as health professionals, we start advocating for it. We tend to get the politicians and outcomes we deserve.

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    3. Judith Olney

      Ms

      In reply to George Crisp

      So an emotive perspective should be irrelevant? Thats the thing though, its very hard to be unemotional about an issue that effects real people, with real feelings, and suffer the real problems of inequality.

      <"There are perfectly good economic, social and health reasons to address inequality.">

      So I can conclude from this that our current batch of politicians, corporate powers, and leaders of the community are either ignorant of these reasons, or don't actually want to address inequality…

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    4. George Crisp

      Medical Practitioner

      In reply to Judith Olney

      Hold on a minute! I did not say that emotive perspective were irrelevant. I was commenting on the context of you previous post and use of "well-intended" that paints the report in an emotive way and in doing so rather diminishes it (or its likelihood of implementation).

      Not quite the same.

      You live in a democracy (not perfect perhaps) and you have the option of speaking out and of voting.

      If you claim there is no point because there are no real options and that nothing will change, then either do something about and get active or do nothing and be part of the problem.

      Your last comment is and assumption and petulant.

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    5. Judith Olney

      Ms

      In reply to George Crisp

      George, what you said was, and I quote, <"The term well intended introduces an emotive perspective that should be irrelevant.">

      Now lets look at what I said, and I quote, <"So an emotive perspective should be irrelevant?">

      How does an emotive perspective, (on what is an emotive issue for many people), diminish the report, or damage the likelihood of it being implemented? In my opinion, it is less likely to be implemented if it is framed in purely unemotional terms, and the real story of inequality…

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  13. Inamdar Hospital

    Inamdar Multispecialty Hospital in Pune

    Focusing on prevention to control the growing health disease helps automatically to prevent growing budget.

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  14. Jason Thompson

    logged in via Twitter

    It strikes me as odd that we spend so much time trying to prevent death and ill-health of specific disease / illness without ever discussing what we would prefer to die from

    In essence, what is the 'least-worst death' we can design both individually, and as a society?

    I'm not suggesting that we all get to choose to run off a cliff, Pythonesque-style, chased by a hoard of bare-chested (insert your preferred style of person here), but that we at least put some thought into engineering an inevitable…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Jason Thompson

      Well put, Jason. A similar view was put by Iona Heath (a London GP) in the BMJ article "What do we want to die from?" (2010).

      This is particularly an issue when extreme old age is combined with dementia. If we treat one acute organ-related complication at a time, at which point do we allow the next one to fail. As Dr Health says, we have to die of something.

      Delaying the inevitable, often seen as "keeping Gran alive" by some family members, may be doing Gran a major disservice. We should all think about this and discuss it with our loved ones. Not just whether we want to be on life-support in ICU, but at what point do we want to be left alone for nature to take its course.

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